Oncology Institute Q1 2025 Earnings Call Transcript

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Provided by Quartr
May 14, 2025
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Operator

Good afternoon, and welcome to the Oncology Institute's First Quarter twenty twenty five Earnings Conference Call. Today's call is being recorded, and we have allocated one hour for prepared remarks and Q and A. At this time, I'd like to turn the conference over to Mark Heplheiser, General Counsel at TOI. Thank you. You may begin.

Mark Hueppelsheuser
Mark Hueppelsheuser
General Counsel at The Oncology Institute

The press release announcing the Oncology Institute's results for the first quarter of twenty twenty five are available at the Investors section of the company's website, theoncologyinstitute.com. A replay of this call will also be available at the company's website after the conclusion of this call. Before we get started, I would like to remind you of the company's Safe Harbor language included within the company's press release for the first quarter twenty twenty five. Management may make forward looking statements, including guidance and underlying assumptions. Forward looking statements are based on expectations that involve risks and uncertainties that could cause actual results to differ materially.

Mark Hueppelsheuser
Mark Hueppelsheuser
General Counsel at The Oncology Institute

For a further discussion of risks related to our business, see our filings with the SEC. This call will also discuss non GAAP financial measures, such as adjusted EBITDA and free cash flow. Reconciliation of these non GAAP measures to the most comparable GAAP measures are included in the earnings release furnished to the SEC and available on our website. Joining me on the call today is our CEO, Dan Vernick and our CFO, Rob Carter. Following our prepared remarks, we'll open the call for your questions. With that, I'll turn the call over to Dan.

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

Thank you, Mark. Good afternoon, everyone, and thank you for joining our first quarter twenty twenty five earnings call. Today, we will discuss first quarter twenty twenty five results with a focus on our strong start to the year and momentum on our path to profitability and positive cash flow by the end of twenty twenty five. I'd like to start with some key updates on Q1 performance. I'm happy to report that revenue for Q1 increased by 10% versus the prior year period.

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

This was driven by a few important factors. Our Retail Pharmacy and Dispensary business continues to grow rapidly and set still records, contributing $49,300,000 in revenue and over $9,000,000 in gross profit in Q1 alone. This business segment grew over 20% in the first quarter of twenty twenty five versus prior year. As noted on our year end call in March, we had a very strong start to the year with new capitated contract wins, adding over 80,000 lives in the first quarter on four agreements across the Florida, California and Nevada markets. Anticipated new capitation contracts in the first half of twenty twenty five are projected to add approximately $50,000,000 in new revenue on an annualized basis.

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

We started our first fully delegated capitation agreement with a major health plan in Florida on March 1, where we are delegated for utilization management, claims, and network. This is going to be our preferred model for health plan relationships going forward, as it gives us differential ability to manage therapeutics with our MSO practice partners, as well as engage with them on future high value opportunities for TOI through our retail pharmacy and clinical trials program. We also signed a new capitation contract in Nevada during the first quarter, which adds over 80,000 Medicaid lives to Clark County with an effective date of July 1. Our fee for service business also returned to growth in the quarter, growing 9% quarter over quarter and 2% year over year, highlighting the impact of our investments in referral relationship management and call center expansion. Achieving profitability and our near term path to positive free cash flow generation in Q4 remain the management team's north star.

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

Some highlights from Q1 related to this effort include adjusted EBITDA loss of $5,100,000 which is on the upper end of our guidance for the quarter gross profit of $17,200,000 which represents growth of 44.1% year over year continued acceleration of near term capitation opportunities in the pipeline, with line of sight to an additional 100,000 lives with anticipated effective dates in Q2 and Q3 focus on growing our radiation oncology and radiopharmaceutical segments, which will be accretive to fee for service margins successful outsourcing of our clinical trials program to Helios Clinical Trials. Helios will operate as a site management organization, and we believe their expertise will dramatically accelerate trials growth in existing and new markets in the second half of the year. However, the structure of the transaction will involve deconsolidating clinical research revenue from QI's income statement, which will modestly impact our full year revenue, which Rob will discuss in more detail shortly. As it stands today, we are not currently projecting a negative impact to drug costs in 2025 related to recently announced tariffs, although we are carefully assessing country of origin for all therapeutics in our portfolio, ensuring we have optionality for all disease classes to protect our margins.

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

Finally, we successfully executed a partial paydown of our convertible preferred debt of $20,000,000 in Q1 with permanent elimination of our minimum cash covenant, followed by capital raise that added $16,000,000 back to our balance sheet. Combined, these transactions strengthen TY's financial position and provide us with greater flexibility to execute on our strategic priorities. Finally, this afternoon, we announced that Doctor. Jeff Langsam is joining the TOI team as Chief Clinical Officer. Jeff joined us from Cigna, where he led national efforts in oncology and specialty pharmacy lending to his role at TOI, where he will lead our efforts around therapeutics, utilization management, and MSO practice engagement.

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

The Chief Clinical Officer role was conceived as part of TOI's evolution in light of the increasingly complex drug and delegation landscape in which TOI operates, allowing us to further distance our capabilities and delivered value. To this end, Doctor. Langsam's role is designed as a net addition to TOI's central clinical infrastructure and is expected to remain collaborative, but ultimately distinct from that of TOI's Chief Medical Officer, Doctor. Yael Podniss, who will continue to serve as the chief clinician overseeing our provider staff. Last week, we also announced that TOI will be presenting clinical trial data at the American Society of Clinical Oncology, ASCO, annual meeting later this month, which demonstrates the value and effectiveness of TOI's clinical model at reducing cost of care while driving improvements in Part A utilization for the patients that we serve.

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

With that, I will turn the call over to Rob to provide additional details on our Q1 performance and 2025 outlook.

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

Thanks, Dan, and good afternoon, everyone. Let's begin by reviewing our financial performance for the quarter. Consolidated revenue for Q1 twenty twenty five was $104,400,000 an increase of 10.3% compared to Q1 twenty twenty four. The increase in revenue was driven primarily by a 24.2% growth in TOI's dispensary segment due to continued growth in the attachment of prescriptions to our patient visits. Notably, we saw our fee for service business returned to growth during the first quarter, increasing 2.3% to $35,600,000 in 2025 versus the prior year period.

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

We are encouraged by the positive patient and referral feedback on TOI services and our strong track record for high quality care combined with our value oriented model gives us confidence in our continued fee for service growth driven by patient choice and health system and community providers patient referrals. Gross profit in Q1 of twenty twenty five was $17,200,000 an increase of 44.1% compared to Q1 of twenty twenty four. This increase is attributed to improvement in revenue and margin in both capitation and fee for service within patient services, as well as improvement in both revenue and margin in TOI's dispensary segment. Margin improvement in the first quarter for both patient services and dispensary businesses is attributable to the recognition of a one time rebate recognized over the fourth quarter of twenty twenty four and first quarter of twenty twenty five related to the renewal of a three year contract with TOI's primary drug supplier. This is not expected to recur in future quarters, although we do expect the benefit of drug price increases to improve over the course of 2025.

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

SG and A including depreciation and amortization was 27,200,000 in Q1 of twenty twenty five, a 9% decline compared to Q1 of twenty twenty four. As a percentage of revenue, SG and A including depreciation and amortization was 26% in the quarter, decreasing five sixty basis points from Q1 of twenty twenty four. Loss from operations was $9,900,000 an improvement from an $18,000,000 loss in Q1 of twenty twenty four. Net loss was $19,600,000 in the quarter, an improvement of $303,000 compared to Q1 of twenty twenty four. Adjusted EBITDA was negative $5,100,000 compared to negative $10,900,000 in Q1 of twenty twenty four.

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

Free cash flow was negative $3,900,000 compared to negative $15,400,000 in Q1 of twenty twenty four. Moving to the balance sheet. As of the end of Q1 twenty twenty five, our cash and cash equivalents balance was $39,800,000 This represents an increase of $3,700,000 of cash and cash equivalents compared to Q1 of twenty twenty four. This is attributable to our capital raise completed in the first quarter as well as efforts to maximize efficiencies in working capital, particularly in accounts receivable and inventory management. Also, were able to reduce our principal balance on our senior secured convertible note through our debt pay down and debt to equity exchange agreement, reducing our quarterly cash interest payments by approximately $1,000,000 annually.

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

As Dan mentioned, in the first quarter, we successfully closed a private placement that resulted in gross proceeds of approximately 16,500,000.0 and further contributes to our prioritization of organic growth and building working capital and liquidity to fund TOI's ongoing growth. In conjunction with this transaction, a major shareholder entered into an exchange agreement whereby approximately $4,100,000 of aggregate principal amount of senior secured convertible notes were exchanged for common equivalent preferred stock and warrants for common stock. Turning to guidance, following our strong first quarter results, we remain confident in our trajectory for the remainder of the year and are reaffirming our fiscal year twenty twenty five guidance. As Dan mentioned earlier, we are outsourcing our clinical trials business to Healios Clinical Trials. Under the terms of the new arrangement, TOI will recognize revenue solely for our share of the profit, which will reduce our expected revenue for the year by $5,000,000 However, we are not revising our full year guidance as we anticipate the increased revenue from the dispensary segment will offset this impact.

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

Therefore, we continue to expect revenue in the range of $460,000,000 to $480,000,000 adjusted EBITDA in the range of negative $8,000,000 to negative $17,000,000 and free cash flow of negative $12,000,000 to negative $21,000,000 for the year. Additionally, we remain on track to deliver positive adjusted EBITDA in the fourth quarter. We will also be providing select guidance for the second quarter of twenty twenty five. In Q2, we expect adjusted EBITDA loss will be in the range of negative 4,000,000 to negative $5,000,000 We expect the positive margin contribution of our fully delegated Florida contract combined with increased encounter volume in radiation oncology and continued growth in our dispensary segment will support the quarter to quarter improvements in adjusted EBITDA. All in all, we believe our execution to date with accelerating growth and improving profitability sets us up well to achieve our full year targets.

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

Before I wrap up, I'd like to briefly address two political headlines that have been topical recently. On the topic of tariffs and any possible impact on TOI, as it currently stands, we have not observed any impact related to tariffs or drug price inflation and our pricing catalogs are fixed through the second quarter with our suppliers. We do not currently anticipate any trends in drug prices that will create risks to our guidance or business performance, but we are continuing to closely monitor the situation and we are actively evaluating country of origin for TOI supply chain. Importantly, due to TOI significant experience actively managing drug formulary as a core capability of our value based care model. We do believe our clinical team has the ability to mitigate any potential impact from tariffs on individual drugs or manufacturers were to materialize.

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

On the topic of executive orders related to pharmaceutical pricing practices, while it's too early to draw any concrete conclusions on the ultimate outcome of drug regulation, we believe there are several factors that make TOI less susceptible to drug pricing impact. The size and scale of our capitated business where drug costs are inversely correlated with profits. The ability of to to control formulary in our clinics and influence formulary in our delegated network to manage from pricing risk within clinical guidelines and the multiple variables that contribute to fee for service and pharmacy drug margins, which constitute the spread between costs and reimbursement rather than the absolute cost of the drugs themselves. This spread relationship may or may not be impacted by any drug pricing reform. With that, I'll turn it back to Dan for closing comments.

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

Thanks, Rob. Looking to the remainder of the year, we will continue to build on our momentum through strong operational management, increased efficiencies and strategic market expansion. As we discussed today, we are executing against a near term path to sustained cash flow positivity and profitability in the second half of twenty twenty five, setting up well to deliver profitable growth in 2026. Our organic fee for service growth, pharmacy attachment and existing value based contract pipeline give me confidence in our strong trajectory, supporting our progress against our strategic priorities. We appreciate the continued support of our shareholders and the great work from our team as we execute against our plans to drive long term shareholder value.

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

With that, we're now ready to take your questions. Operator?

Operator

Thank you. We will now be conducting a question and answer star one on your telephone keypad. A confirmation tone will indicate that you are in the question queue. You may press star two to remove yourself from the queue. For participants using speaker equipment, it may be necessary to pick up a handset before pressing the star keys.

Operator

And our first question comes from David Larson with BTIG. Please proceed with your question.

David Larsen
Managing Director at BTIG

Hey, congratulations on a good start to the year. Can you talk a little bit about the gross profit growth of 44% year over year? What was the main driver of that? In my mind, that's obviously a very important metric considering like I think for 2024 gross profit actually maybe declined by 9% year over year. So thanks very much. Driver of gross profit would be great.

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

Yeah David, hey this is Rob. Thanks for the question. So a couple of things contributing to this. First off the bat is the one time rebate that we mentioned that was attributable to a new contract signed with our primary distributor. The second piece is that as you know, our drug pricing changes quarterly.

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

January is a big quarter for drug price changes. It was relatively favorable from what we've seen in previous years. So that combined with some nice volume increases particularly on the dispensary side contributed to the pickup in overall margin.

David Larsen
Managing Director at BTIG

How much was the rebate for please?

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

About 1,500,000.0

David Larsen
Managing Director at BTIG

1 point 5 million dollars Okay. It looks like your gross profit on a year over year basis was up more than $5,000,000 So there was still a very good growth beyond that. Okay. And then can you talk a little bit about your fee for service revenue please, your patient service revenue? Like the cap revenue, was that down 1% year over year and fee for service was up 2% year over year?

David Larsen
Managing Director at BTIG

I guess I would have thought there would have been more growth than that. And do I see 81 clinics compared to 87 clinics in the year ago period? Was there a change there? Just any thoughts around the patient service revenue growth? It looked a little bit light to me on a year over year basis.

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

Yes, I'll start on the cap side. So as we've called out, the pipeline is robust, numerous launches. The most meaningful and impactful launched in March, that's the fully delegated contract in Florida. The impact of that will be seen to a much greater degree later in the year. Also a couple other launches here in the next upcoming months that will also contribute significantly.

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

And hi, David, it's

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

Dan Burnick. I can comment on the sites going from 87 to 81. Compared to this quarter a year ago, we closed a couple low volume locations that were unprofitable for TOI. And you're seeing that reflected in the change from 87 to 81. However, I will call out that we've added over 30 additional sites of care in the Florida market.

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

So, as we move to this hybrid employed and model in our delegated contract, our total available types of care actually went up.

David Larsen
Managing Director at BTIG

Right. I'll take earnings growth over revenue growth all day long. So, okay, great. And then can you talk a little bit about your SG and A management? It looks like SG and A costs declined 11% year over year and by like around 600 basis points of revenue, which is obviously great.

David Larsen
Managing Director at BTIG

Just what are your thoughts in terms of like total SG and A savings expectations for 2025?

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

Yes, we remain committed to keeping SG and A roughly flat for 2025, which I think is important to note given our overall projections on growth for the organization. We've been very disciplined at our approach related to vendor and labor management and continue to seek ways to operate our business more efficiently. We have a number of initiatives going on in the technology side as well, where we are going to be looking to engage AgenTek AI into some key workflow processes over the next twelve to eighteen months, which we believe will drive even greater efficiencies and manage down our SG and A as a percent of revenue.

David Larsen
Managing Director at BTIG

Okay. And then in 2024, there was a pretty significant impact from DIR fees. I did not hear you mention those on this call. Are we now past DIR fees or is that still a potential headwind this year?

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

No, we are past DIR fees. DIR fees as they used to exist no longer do. It's all priced as a point of sale. The impact that we saw last year was overall reimbursement pressure as that change went into effect. And so that's behind us and things are looking significantly better relative to last year.

David Larsen
Managing Director at BTIG

So that was a $15,000,000 drag on revenue and EBITDA last year and you have completely sort of lapped that. Is that correct?

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

That's right. That's right. What we consider as dispensary margins going forward are steady state.

David Larsen
Managing Director at BTIG

Okay, good. And then there was one large payer contract that I think was maybe 11% of revenue that kind of disappeared in 2024. I think you've kind of fully lapped that. And what I'm also hearing from you is you're actually entering into, I think you highlighted four new arrangements this quarter, and we should see patient service revenue ramp as we progress through the year because of these new contracts. Is that correct?

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

That's correct. Yes. That was in reference to the new capitated contract signed as part of our value based arrangements. But all those are tied to fee for service revenue that flows through our dispensary. And then we are seeing additional growth in just fee for service patient services revenue.

David Larsen
Managing Director at BTIG

Can you provide a little color around why that contract ended and just like the purpose of that question is, are there any other contracts in 2025 that might be at risk? How is your relationship with some of the largest plans that you're working with?

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

Yeah, that was a contract that was an old contract where we had kind of a mutually agreeable termination related to a number of just disputes. So, we overall have a very stable contract portfolio. We've got incredibly low historical contract turn rate and do a lot to manage our client relationships and show the value that we provide. So, I don't anticipate any likely terminations as we progress through 2025.

David Larsen
Managing Director at BTIG

Okay. And then do you have any thoughts on IV margins? I think that was a little bit of a headwind early last year. Just any thoughts there?

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

Yes. Similar to dispensary, what we've seen so far based on new year pricing is favorable to what we were expecting, certainly favorable to 2024. The general progression that we see throughout the year is improvement in overall margins. And so things are going slightly better than planned there.

David Larsen
Managing Director at BTIG

Okay. That's great. And then you mentioned tariffs and this executive order and then there's also the most favored nation clause or executive order that may or may not get through. So if drug prices, let's say go up by 25% across the board, is that good or is that bad for the Oncology Institute? Because higher drug prices would eventually result in more revenue and probably more margin for you in your fee for service book. Is that correct?

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

Yeah, yeah, that's accurate.

David Larsen
Managing Director at BTIG

And in dispensing. And it's mainly Medicare Part B as in boy, not Medicare Part D. Is that correct?

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

Sorry, mainly in terms of what?

David Larsen
Managing Director at BTIG

In terms of reimbursement for fee for service revenue and also

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

Yes, that's correct. I mean hypothetically it would impact B and D.

David Larsen
Managing Director at BTIG

Okay.

David Larsen
Managing Director at BTIG

Okay. It looks like a pretty good quarter. Congrats on good start to the year. And thanks for taking my questions. I'll hop back in the queue.

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

Thanks so much, David. We appreciate it.

Operator

Thank you. And our next question comes from Yuan Zi with B. Riley Securities. Please proceed with your question.

Yuan Zhi
Managing Director at B.Riley Securities

Thank you for taking our questions. Dan, maybe we can start with the recent report by UnitedHealth. It was reported that the seniors within their Medicare Advantage plan used health care services twice as much as last year. I want to check if you noticed a similar trend within oncology practice, or is it related to some other diseases or surgery practice?

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

Yeah, I can't speak to what other drivers might be associated with that. What I can say is that we track that on a very close basis for the oncology care needs of the populations we serve. And, you know, we haven't seen a jump to the magnitude that United mentioned. I don't know if that's driven by other drugs outside of oncology or other utilization trends, have been more unfavorable than expected.

Yuan Zhi
Managing Director at B.Riley Securities

Yep, maybe a follow-up question here. So they also reported the enrolled patients are sicker. I guess my question is two parts. First, did you notice similar trends there? And two, when you negotiate a value based contract with the payer, is it based on historical data from insurance companies or is it based on your own database and external service to reflect the latest patient profile?

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

Yeah, so for the first part of the question, we haven't noticed a change in prevalence or average stage of cancer patients we're treating. So, that would correlate to a sicker population that hasn't pivoted that we've noticed. In terms of pricing, we do that based off of historical utilization up through the most recent period before we make a contract go effective. So, we have a pretty recent trend on utilization. And then we factor in a cost trend related to historical drug price changes as well in our forward looking utilization.

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

So, that's pretty real time as far as how contributing to the pricing of our contracts.

Yuan Zhi
Managing Director at B.Riley Securities

Yep. Got it. So on your new territory part, is there any metrics you can share on the progress to fill up the capacities in your Florida clinic, whether it is the lives under management in terms of overall capacity or patient encounter?

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

I'm so sorry, Yuan, could you please repeat the first part of the question?

Yuan Zhi
Managing Director at B.Riley Securities

Yeah, is there any metrics you can share on the progress to fill up capacities in your Florida clinic?

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

Yeah, absolutely. So we track, we project encounters by market and by down to the detail by clinic across our portfolio as we forecast each year. And we are tracking our right to plan in terms of capacity fill in both our legacy markets and then the newer markets like Florida. There is some additional upside we believe in the back half of this year related to some contract wins, which are in the pipeline, but not in the forecast. So, all is going to plan as far as slowing capacity.

Yuan Zhi
Managing Director at B.Riley Securities

Yep. Got it. And maybe one last question from me. Just to clarify, do you aim to have a cash flow positivity and profitability in the second half of twenty twenty five versus 4Q twenty twenty five from your last earnings call? And was there any change there?

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

No change to guide. We expect full cash flow and adjusted EBITDA positivity in Q4 of twenty twenty five.

Yuan Zhi
Managing Director at B.Riley Securities

Got it. Thank you.

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

Thanks, Juan.

Operator

Thank you. Our next question comes from the line of Bill Sutherland with The Benchmark Company. Please proceed with your question.

Bill Sutherland
Director of Research at The Benchmark Company LLC

Thanks, operator. Hey, guys. Thanks for taking the questions. Most of mine have been asked. But going back to a couple of the key business metrics, the slight decline in the lives under value based contracts, is that related to that contract you were talking about that went away last year?

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

Yeah, exactly. As measured by lives, that is a decrease. But I would just keep in mind that there's a product mix in every contract, and that specific contract had a heavy predominance of Medi Cal and commercial lives, which are high numbers but low PMPM reimbursement typically versus our newer markets where we're signing MA only contracts which are lower lives but higher reimbursement.

Bill Sutherland
Director of Research at The Benchmark Company LLC

Got it. Any important renewals coming up as far as contracts?

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

Nothing significant to mention, no. Most of our relationships are multi year, many of them date back over ten years. They typically auto renew and then, yeah, there's no significant renewals in the near future

Bill Sutherland
Director of Research at The Benchmark Company LLC

then the guidance for the year, is there any pipeline conversion that you need to execute to do the numbers or is it basically all set up at this point?

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

Yeah, we don't need any additional value based contracts that are in the pipeline to achieve guidance. So any additional wins that are in the pipeline would be upside to what we've guided to.

Bill Sutherland
Director of Research at The Benchmark Company LLC

Okay. And finally, it's an interesting trend and I'm not sure if it's not really part of your model, but I keep hearing from health systems about trying to do more of the cancer cases in the home with everything else. How does that trend kind of segue with your business, if at all? Thanks.

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

Yeah, I mean, think it would be a very positive trend for if more cancer care was delivered in the home. We work pretty closely with our pair partners and trying to find innovative ways to deliver therapeutics in the home. I'd say it's much easier on the specialty medication side than it is with infusible. But that being said, there's no reason why we can't achieve that as a future state. So again, that gets back to our mission to deliver higher level care in the community and something we would definitely want to be a part of.

Bill Sutherland
Director of Research at The Benchmark Company LLC

Got it. Okay. Nice quarter. Thanks very much.

Operator

Thanks, And our next question comes from Robert LeBoyer with Noble Capital Markets. Please proceed with your question.

Robert Leboyer
Senior Biotechnology Analyst at Noble Capital Markets

Thank you. Congratulations on a nice quarter. Question has to do with the number of lives under contract and covered by the managed care policies. The previous number was 1,900,000. It looks like 're adding a $100,000 in the first and second quarter and then another $80,000 in Nevada after July 1.

Robert Leboyer
Senior Biotechnology Analyst at Noble Capital Markets

So is that just simply additive to the 1.9 or is there some more nuanced way to project the number of lives that are covered?

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

No, it's additive. That's the right way of thinking about it. The nuance in terms of modeling the financial impact would be where those lives are located. And so as we've talked about before in some of our material, there is a higher PMPM for contracts in Nevada and Florida than there is in California due to the overall cost of care. So that would be the one nuance to consider.

Robert Leboyer
Senior Biotechnology Analyst at Noble Capital Markets

Okay, great. And in terms of seasonality or any kind of other trends that you see throughout the year, you noticed anything in the first quarter versus other quarters throughout the year at this point?

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

Yes. So our first quarter is always seasonally the lowest in terms of encounter volume. And so that's part of the whole picture when you're looking at the full year guide. We knew that it would be the lowest quarter in terms of revenue, the worst quarter in terms of adjusted EBITDA loss. And so we expect to see progressive improvement quarter over quarter, both due to seasonality as well as the addition of new contracts and lives and encounter growth.

Robert Leboyer
Senior Biotechnology Analyst at Noble Capital Markets

Okay, good. And just one last question. In terms of the top three plans and clients that you have, what would be the percentage of each of the top three in terms of revenues?

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

As a percent of cap revenue, it's probably about 20%, if you're looking at the top three contracts.

Robert Leboyer
Senior Biotechnology Analyst at Noble Capital Markets

Okay, great. All right, thank you very much.

Rob Carter
Rob Carter
Chief Financial Officer at The Oncology Institute

Thank you.

Daniel Virnich
Daniel Virnich
Chief Executive Officer at The Oncology Institute

Thank you, Robert.

Operator

Thank you. And as a reminder, this is your final chance to ask a question. If you would like to, please press star one on your telephone keypad. Okay. There are no further questions at this time. And with that, this does conclude

Executives
    • Mark Hueppelsheuser
      Mark Hueppelsheuser
      General Counsel
    • Daniel Virnich
      Daniel Virnich
      Chief Executive Officer
    • Rob Carter
      Rob Carter
      Chief Financial Officer
Analysts
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Key Takeaways

  • On Q1 2025 revenue of $104.4 million grew 10.3% year-over-year, led by a 20% jump in Retail Pharmacy/Dispensary revenue ($49.3 million) and 80,000 new lives added under capitation yielding $50 million of annualized revenue; fee-for-service also returned to growth, up 2%.
  • Adjusted EBITDA loss narrowed to –$5.1 million (at the upper end of guidance) and gross profit rose 44.1% to $17.2 million thanks to a one-time rebate, while free cash flow loss improved to –$3.9 million, positioning the company to achieve positive EBITDA and free cash flow by Q4 2025.
  • The first fully delegated capitation agreement in Florida launched March 1, complemented by a new Nevada Medicaid deal effective July 1, and a pipeline of 100,000 additional lives set to go live in Q2/Q3, solidifying the company’s preferred model for margin control and network management.
  • Oncology Institute outsourced its clinical trials program to Helios Clinical Trials as a site management organization, which will accelerate growth in H2 2025 but deconsolidate approximately $5 million of trial revenue, with dispensary segment growth expected to offset this impact.
  • Balance sheet strengthened via a $20 million convertible-debt paydown, elimination of the minimum cash covenant, and a $16 million capital raise, ending Q1 with $39.8 million cash; FY 2025 guidance of $460–480 million revenue, adjusted EBITDA –$8 million to –$17 million, and free cash flow –$12 million to –$21 million was reaffirmed.
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Earnings Conference Call
Oncology Institute Q1 2025
00:00 / 00:00

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